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HomeMy WebLinkAboutBLDG-22-004769 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 28,2022 PERMIT# BLDG-22-004769 JOBSITE ADDRESS 5 OYSTER COVE RD OWNER'S NAME LAMPMAN JON N CO-TRS G OWNER ADDRESS LAMPMAN JANET A CO-TRS 2083 PIERCE CT EL CAJON CA 92019 TEL _ TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY I NEW: 0 RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER • BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR r FURNACE , . GENERATOR GRILLE , INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 2 0 OTHER DESCRIPTION:Removal of existing gas hot water heater and gas boiler-capping both lines,no longer being used. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY 0 BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Albert Cassano LICENSE# 9015 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: Cape Cod Mechanical Systems,Inc. ADDRESS. 8 Fruean Way, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX CELL , EMAIL SiLON M31A3N NVId #1IW213d $ 33d 11INi13d 3H1 SV SAS NOI1VOIlddV SIH1 ON sa, S310N N01103dSNI 1VNId AINO 3Sl 210133dSNI 210d 30Vd SIH1 S310N NOI133dSNI SVO H00021